Quality matters

Jo-Anne Wilson, Registered Manager of Galanos House

I caught site of Jane in reception, she had a spring in her step and a smile on her face. ‘Thank you, thank you,’ she sang out… ‘I have my mum back’.

It was only a few weeks earlier that I had spent several hours with a tearful, tired and deflated Jane. Mum had been living alone at home, struggling with early stage dementia and failing eyesight. Her perception of danger reduced, she was regularly found by neighbours out on the street in her night clothes. Jane was tired from the nightly calls, never sleeping properly, just in case, tired of battling to get her mother assessed and funded, tired of juggling her family, work and mum, and tired of feeling guilty as she didn’t feel she was doing anything well.

In social and nursing care we are in a privileged position, we come into contact with people at some of the most vulnerable times of their lives. We travel with them on some of the most difficult journeys they will have. By working in collaboration with colleagues in the health and social care sector, we can make a huge difference to people’s lives, not only to those we care for directly but also their loved ones.

I am often heard to say, the residents we care for have changed their address not their lives; if anything, with our care and support we should be able to enhance lives and daily living. We can give families back relationships and time to be together.

Thinking back to when I was a young carer then a student nurse, many moons ago, the question that would constantly come to my lips was, ‘Why?’ Why is it acceptable for someone to be restrained in a chair with a table attached? Why are we transferring people to commodes in the day room? Why is that person being left in a urine soaked bed every night? Why has that person had their hands bandaged to the bed rails? Why does everyone have to wear a nightdress with a split up the back? Why was that person locked away to stop them getting out? Why did that person scream in pain? So many questions.

In 30-odd years we have come so far as an industry that situations like that are not the norm, not acceptable and would not be tolerated. Yet we still hear of complacent, poor care that is lacking in compassion and love.

So today the question I ask is, ‘Why not’?

As a professional, a manager and a leader, I believe that we should constantly challenge in order to move forwards. The aging population has changed, the world has become a much smaller place with today’s technologies and the expectation of those using our services is greater.

Providing quality care is not rocket science, although science and research play a greater part that ever before. Let’s always think of ‘the Mum test’. Would it be good enough for your mum, dad, brother, sister, aunt or uncle? The people we care for are no different to us; they have all had full lives, relationships, hopes and dreams, memories of good times and bad. Admission to a care facility is not the end of that life, just another chapter with new memories to be made. Let’s make those new memories great ones.

In order to truly provide a quality service we must begin by valuing the people we care for. We need to know who they were and who they are whilst they live with us, not during their obituary once they have died. We need to invest time to find out the life histories and pasts of people, not just to complete the paperwork but to truly enhance the opportunities we can provide.

We need to make our care offering relevant to their lives, giving the ex-nurse who has dementia bandages to roll; giving the wife and mother the opportunity to sort the washing out and care for others; giving the French polisher a table to sand down and polish; giving the former solicitor papers to sort out, giving the hairdresser rollers to put into sizes, giving the cook the opportunity to menu plan and cook. None of these examples are costly but they do need for staff to invest time, understanding and thought.

We need to turn care into an industry of ‘can dos’ rather than cant’s. We need to challenge the perception of keeping people safe by not allowing; to managing risk positively to allow and enable. The Mental Capacity Act highlights that not all decisions that people make are wise ones but does that mean that we should prevent them from making them? No – let’s start to consider what really matters to people.

The complexity of care needs is ever increasing with an aging population living much longer. The cost of care is rising and accessing adequate funding is more and more difficult. Support posts are being withdrawn and services are stretched. Through all of this the people in our services are relying on us to keep them safe and well cared for. With an emphasis on outcomes, we must ask people for feedback and act on their comments.

If we are to be truly person-centred, the person we care for should be at the heart of what we do. As a manager, it can be sometimes difficult to oversee a service that doesn’t have a one-size-fits-all approach but what a joy to see people smiling, happy, engaged and living. Let’s start thinking outside the box, being flexible in our approach and making a difference.

As a leader in social care, it is a delight when staff approach with an idea and it is wonderful to see them implement new ways of working, taking ownership and pride in what they do. Staff are our biggest assets but can also be our biggest downfall. With issues around staff retention, rising costs and social care budgets being squeezed, it would be easy to not invest in the workforce. However it is that workforce that makes the difference between a good and outstanding service to one that is lacking or inadequate.

Staff are the people we leave behind to care for our relatives, residents and patients when we go home. We need staff that are flexible, open, skilled and compassionate. The work is sometimes thankless, physically demanding and emotionally draining. As managers and leaders we need to recognise that. The vast majority of our staff want to go home knowing that they have made a difference to someone’s day. A heartfelt thank you goes a long way and can make a difficult day seem better.

Let’s ask questions: what does my service look like, smell like, sound like, feel like? When I take time to sit and really observe, is it a place I would like to live in? Is it a positive experience, are people kind to each other? Is there a sense of wellbeing? Is it a happy place? Do the people working and living there smile? Does it feel like a place I want to be in?

Let’s be honest about the challenges: being open and using our Duty of Candour to accept when things go wrong, learning from complaints and difficulties, working and confronting the restraints we have, questioning care that doesn’t meet our expectations. Reporting care that doesn’t reach the standards and could do harm.

Let’s share good ideas, things that work: staff wearing their pyjamas at night when working with people with dementia, using Namaste for people at the end stages of their lives, living in people’s reality and journeying with them, having a friend to the end, being Resident of the Week, using life stories to shape care and occupation, making risk assessments positive and enabling, reducing hospital admissions and enabling people to die at home with people that love them, valuing the people we care for by making them partners in the care process.

Let’s make sure that quality really matters.